Surgical electrode



July 17, 1934. c WAPPLER 1,967,015

SURGICAL ELECTRODE Filed Dec. 19. 1931 2 Sheets-Sheet 1 mil I N V EN TOR. [indent/5 amlaili qu lej;

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July 17, 1934-. c WAPPLER 1,967,015

SURGICAL ELECTRODE 2 Sheets-Sheet 2 Filed. Dec. 19, 1931 INVENTOR.

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Patented July 17, 1934 UNITED STATES PATENT QFFICE My present invention relates generally to surgical instruments, and has particular reference to a new type of electrode instrument.

As a result of relatively recent increased recog- 5. nition and use of the valuable characteristics of high-frequency alternating currents in the surgical and medical arts, and with the advent of new and improved methods and apparatus for generating sustained low-voltage, high-frequency currents, it has become increasingly necessary to devise new and improved instruments to meet the changing requirements of the art. Modern high-frequency electrotherapy, which appears to be still in its infancy, and the corresponding developments and advancesin the arts of electrosurgery and electromedicine, have rendered possible and practical my new and improved modes of treatment and operation.

It is a general object of my present invention 20 to provide a new and improved type of electrode instrument which is designed primarily to meet certain of the requirements of the new technique which is in process of development.

More particularly, my invention relates to what may be termed coagulation electrodes or tissue-shrinkage electrodes. Such electrodes are designed to transmit high-frequency alternating current to body tissues in a manner whereby the application of the current may be caused to pro- 30l duce a mild coagulation or cooking of the tissues, this treatment being distinct from a burning or searing, as in cauterization, and similarly distinct from a pure heating effect in which the tissues are not afiected at all.

A mild coagulation of tissues results chiefly in a dehydration, as a result of which the tissues are caused to shrink.

For the sake of convenience, I may therefore designate one type of the present instrument, be- 40. cause of its manner of contemplated use, as a shrinkage electrode; and I have'designated another type as a stricture electrode; but it will be understood that the instruments constructed in accordance with my present invention are not 45. necessarily limited in their uses to such particular purposes. I

An important feature of my present invention lies in the provision of an electrode instrument which consists of (a) a tube provided with 50. a lateral fenestra and adapted to accommodate a telescope which will include the fenestra Within its field of vision, and (b) an electrode wire or the like arranged in a particular manner in association with the fenestra. I

A more particular feature of my invention lies in an arrangement whereby the operative electrode wire is secured in permanent relationship to the tube forming part of the instrument. More especially, my present type of instrument is characterized by the arrangement of an electrode wire extending longitudinally across the fenestra of a tube of the character described, the wire being secured to the tube both forwardly and rearwardly of the fenestra.

Another feature of my invention lies in the provision of a conducting member which extends longitudinally with respect to the tube and which is secured to one wall of the tube in a novel and improved manner, the conducting member communicating at its forward end with the electrode wire hereinbefore mentioned.

I achieve the foregoing objects, and such other objects as may hereinafter appear or be pointed out, in the manner illustratively exemplified in the accompanying drawings, wherein Figure 1 is a longitudinal view of an electrode instrument of the present character;

Figure 2 is a View of the instrument of Figure 1, turned through 90, portions being broken away and shown in section; 1

Figure 3 is a view similar to Figure 1, showing the forward portion of a modified type of instrument; 7

Figure 4 is an enlarged cross-sectional view taken substantially along the line H of Fig: ure 3;

Figure 5 is a view of the instrument of Figure 3 taken substantially along the direction 5-5 of Figure 3, with parts broken away and in section;

Figure 6 is an enlarged cross-sectional view taken substantially along the line 66 of Figure 5;

Figure 7 is a side view of a modified type of instrument;

Figure 8 is a View taken in the same direction as Figure 7, showing the forward portion of the instrument on an enlarged scale and, partly broken away and in section; and

Figure 9 is a cross-sectional view takensubstantially along the line 9-9 of Figure 8.

Referringto Figures 1 and 2, it will be observed that I have provided an elongated tube 15 provided near its forward end with a lateral fenestra 16, and near its rear end with a post 17 adapted to accommodate an electric connection'terminal' 18. Usually, though not necessarily, the instrument is provided with petcocks 19 to control the application of a liquid medium, such as water, to the area to be treated.

In accordance with my invention, the tube is of a character to accommodate therein a telescope which will command a field of vision which includes the fenestra 16. For illustrative purposes, I have shown associated with the tube 15 a telescope 20 which is in the form of a long, thin, and substantially straight tube and which may, for example, be constructed in the manner more fully illustrated in United States Letters Patent No. 1,680,491. The telescope has an eyepiece 21 at its rear end and an objective lens 22 near its forward end. In the form herein illustrated by way of example, the telescope is also provided with an illuminating lamp 23, but

it will be understood that other illuminating means may, if desired, be provided. I In accordance with my invention, an uninsulated electrode wire or the like 24 is arranged longitudinally across the fenestra 16, preferably along the medial line of the fenestra and closely adjacent to the external wall of the tube 15. At its rear end, the wire 24 is connected with a longitudinal conducting member which extends rearwardly along one wall of the tube 15 into electrical connection with the terminal 18.

By virtue of the fact that modern improvements in the art of generating suitable high-frequency currents permit relatively thin insulations to be employed with safety, I am enabled to secure the conducting member to the tube 15 in a novel and improved manner. Thus, I ensheath the conducting member in a tube of thin insulation 25, and I provide around the latter an outer sheath of metal 26. The latter is bonded to the inner surface of one wall of the tube 15, as by soldering or welding. This serves to secure the rear portion of the electrode wire 24 rearwardly of the fenestra 16 in firm association with the tube 15.

At the forward tip of the tube 15, I provide an exteriorly rounded plug or body 2'7 which is composed of insulating material and in which the forward end of the wire 24 is securely anchored, as shown most clearly in Figure 2.

The wire 24, though uninsulated, is thus effectively maintained in insulated relationship to the tube 15 itself, which is preferably of conducting material such as metal. The tube may, however, be made partly or wholly of insulating material. It will be understood that the conducting member is associated with the binding post 18 in any suitable or desiredmanner without impairing the insulated relationship of the wire 24 from the tube 15 or other associated parts of the device.

The fenestra 16 is made sufficiently narrow to prevent the wall of a cavity into which the instrument is inserted from protruding into the tube 15 to any substantial degree. As a result, when the tube 15 is inserted into a cavity and rotated, those cavity wall portions which are contiguous to the operative electrode wire 24 will be subjected to the high-frequency current which is communicated to this wire through suitable connections with the terminal 18. A mild coagulating or dehydrating effect is therefore accomplished, as a result of which the tissues forming the walls of the cavity may be caused to shrink. In many cases, this shrinkage is, by itself, the end which is desired to be accomplished; in other cases it is merely preliminary to further operative treatments. In any event, my present instrument provides for an efficient and simple manner of accomplishing such shrinkage, and it I will be observed that the effect of the wire 24 is capable of clear and unimpeded vision by virtue of its present arrangement.

The relatively thin character of the insulation 25 around the conducting member permits the entire instrument to be made extremely compact and narrow. The tube of Figure 1, for example, is approximately one-quarter of an inch in external diameter. As a result, it is capable of insertion into even the narrowest body cavities, and the particular and novel arrangement of the electrode wire 24 permits this insertion, and the subsequent operation, to be effected with a maximum of safety and facility.

Sometimes, though not necessarily, it is preferable to employ the instrument of Figures 1 and 2 with an outer fenestra-ted tube into which the tube 15 fits in a snug manner. Thus, if the outer tube hasa fenestra which is slightly shorter in length than the fenestra 16, the area subjected to the dehydration treatment may be conveniently and accurately limited.

In Figures 3-6, I have illustrated a slightly modified type of instrument which is designed to be used wherein the coagulation or dehydration effect is to be accomplished on the remote side of what I may term a precipice. Thus, it is frequently desirable to carry out the present treatment upon tissues within a relatively large cavity or vessel which lies at the inner end of a constricted passage or cavity.

In this form of instrument, the tube which corresponds to the tube 15 of Figures 1 and 2 is provided with a straight body portion 30 and with an inclined forward portion 31. The rearwardly disposed face or wall of the inclined portion 31 is provided with the fenestra 32, and an un insulated electrode wire 33 is arranged longitudinally across this fenestra in substantially the manner hereinbefore described and illustrated in connection with the wire 24. Thus, upon referring to Figures 3 and 5, it will be observed that the tip of the inclined portion 31 is provided with the exteriorly rounded plug or body 34 of insulating material, the forward end of the wire 33 being anchored therein. At the rear end of the wire 33, communication is made with a conducting member which extends rearwardly and longitudinally through the body portion 30 of the tube. In accordance with my invention, this conducting member is provided with a sheath 35 of relatively thin insulation, the latter being enclosed in an outer sheath 36, preferably of metal, and the sheath 36 being bonded, as by soldering or welding, to the inner surface of one longitudinal wall of the tube 30.

It will be understood that suitable connection is made at the rear of the instrument with an electric terminal or the like.

To permit the fenestra 32 to be visualized, the tube 30 is adapted to accommodate a telescope which will include, the fenestra within its field of vision; but since the fenestra is disposed in a slightly different manner from that illustrated in Figures 1 and 2, it is preferable to employ a slightly different type of telescope. I have illustratively shown a telescopic tube 37 which is substantially straight and which is provided with the objective 38 which commands a field of vision approximately indicated by the dot-and-dash lines 39. In the form illustrated, merely by way of example, I have shown the telescope 3'7 provided with an illuminating lamp 40.

To permit such telescope to be accommodated within the tube 30 so that the fenestra 32 will fall within its field of vision, I provide the tube 30 with an opening 41 which is arranged at the forward end of the straight body portion of the tube. This opening permits the telescope to pass forwardly therethrough in the manner illustrated in Figure 5, although it will be understood that this advancement of the telescope will in all probability be accomplished after the instrument has been advanced to position the inclined forward portion 31 in the relatively large chamber or cavity whose wall is to be treated.

By slightly rotating the instrument, those wall portions which lie contiguous to the electrode wire 33 will be subjected to a mild coagulation or dehydration, and this may be accomplished with the maximum safety and facility, and under vision.

In Figures 7 and 8, I have illustrated a slightly modified type of instrument of the present character which I have, for convenience, designated as a stricture electrode. This instrument accomplishes coagulation and dehydration, as hereinbefore described, but in addition it has the capability of working its way forwardly through a relatively constricted cavity portion, as, for example, one which is almost completely blocked or impeded by a protrusion, swelling, or the like.

In the instrument of Figures 7-9, a tube 50 is provided with the lateral fenestra 51 near its forward end, and it is adapted to accommodate a telescope 52 having the rear eyepiece 53 and the objective lens 54. Preferably, a telescope is employed, as hereinbefore described, which carries an illuminating lamp 55 at its forward end.

At the forward tip of the tube 50 is a plug or body 56 which is of insulating material and which has the forward end of an uninsulated electrode wire 5'7 securely anchored therein. This wire is arranged longitudinally across the fenestra 51, as in the preceding embodiments, but it is caused to project outwardly by a slight extent, as indicated most clearly in the drawings. At its rear end, the wire communicates with a conducting member ensheathed in the insulating tube 58, which is of relatively thin material and which is, itself, ensheathed in the outer tube 59 which is preferably of metal. The sheath 59 is bonded, as by soldering or welding, to one of the walls of the tube 50; but in this embodiment the tube 59 is secured to the outer surface of the wall of the tube 50.

Suitable electrical connection is made, at the rear of the conducting member, with a suitable terminal arranged preferably within a post 60 of the character illustrated in Figure '7.

The instrument of Figures 7-9 is exceptionally thin, the exterior diameter of the tube 50 being approximately one-eighth of an inch, and in use the instrument may be advanced forwardly through the narrowest of cavities or channels. When a stricture is encountered, the forward portion 61 of the wire 57 effects a shrinkage of tissue which permits the instrument to be further advanced; and after the stricture has been passed, a slight rotation of the entire instrument accomplishes a more comprehensive shrinkage of whatever tissues are contiguous to the wire 57.

It will be obvious that changes in the details herein described and illustrated for the purpose of explaining the nature of my invention may be made by those skilled in the art without departing from the spirit and scope of the invention as expressed in the appended claims. It is therefore intended that these details be interpreted as illustrative, and not in a limiting sense.

Having thus described my invention, and illustrated its use, what I claim as new and desire to secure by Letters Patent is- 1. In an instrument of the character described, a tube having a lateral fenestra, said tube being adapted to accommodate a telescope which will include said fenestra within its field of vision, a bare electrode wire arranged longitudinally across said fenestra and secured to the tube in insulated relationship both forwardly and rearwardly of said fenestra, and means insulated from the tube for feeding a high-frequency electric current to said wire.

2. In an instrument of the character described, a tube having a lateral fenestra, said tube being adapted to accommodate a telescope which will include said fenestra within its field of vision, a bare electrode wire arranged longitudinally across said fenestra and secured to the tube both forwardly and rearwardly of said fenestra, and means for insulating said wire from said tube.

3. In an instrument of the character described, a tube having a lateral fenestra, said tube being adapted to accommodate a telescope which will include said fenestra within its field of vision, a bare electrode wire arranged longitudinally across said fenestra and secured to the tube both forwardly and rearwardly of said fenestra, and means for insulating said wire from said tube; said means including a body of insulating material secured within the tube forwardly of the fenestra and having the forward end of said wire anchored therein.

4. In an instrument of the character described, a tube having a lateral fenestra, said tube being adapted to accommodate a telescope which will include said fenestra within its field of vision, a bare electrode wire arranged longitudinally across said fenestra and secured to the tube in insulated relationship forwardly of the fenestra, an insulated conducting member secured to a wall of the tube and extending longitudinally rearward from said wire to the rear portion of the tube, and means for feeding a high-frequency electric current to the rear end of said conducting member and thereby to said wire.

5. In an instrument of the character described, a tube having a straight body portion adapted to accommodate a telescope, said tube having an inclined forward portion provided with a fenestra in its rearwardly disposed wall, said tube being also provided with an opening at the forward end of the body portion to permit said telescope to project therethrough and thereby include said fenestra within its field of vision, a bare electrode wire arranged longitudinally across said fenestra and secured to said forward tube portion both forwardly and rearwardly of said fenestra, and means for insulating said wire from said tube.

6. In an instrument of the character described, a tube having a lateral fenestra near its forward end, said tube being adapted to accommodate a telescope which will include said fenestra within its field of vision, a plug of insulating material at the forward tip of the tube, an insulated conducting member secured to a wall of the tube and extending longitudinally along the tube from the rear thereof to said fenestra, and a bare electrode wire arranged longitudinally across said fenestra, the rear end of said wire being electrically connected with said conducting member and the forward end of said wire being anchored in said plug.

FREDERICK CHARLES WAPPLER. 

